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Top 3 Treatments for Fear of Flying

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Photo by: J W Foster

Last week we discussed fear of flying and I said there are different types of treatments for it. Today, I’ll review them with you. I’m going to show you the top 3 used by most mental health providers: Cognitive-Behavioral Therapy (CBT), Medicines, and Virtual Reality.

1. CBT: This treatment is based on learning to confront the fear of flying by becoming your own therapist. Whenever you have scary thoughts about flying, you practice talking to yourself in a calm, supportive manner. Instead of saying, “Oh my God, I’m going to die.” You might say, “It’s okay to feel nervous, but it’s just a feeling, I don’t have to let my feelings run my life.”  Or you might do some deep abdominal breathing to respond to the anxiety with relaxation instead of panic.

Systematic Desensitization (Also a form of CBT)
This treatment depends on guided practice starting with low-anxiety thoughts and images and progressing to high anxiety, and finally to boarding the plane.  The whole thing is set up on a hierarchy of avoidance which ranks your fears on a scale of say 1-10.

The first item you practice elicits minimal fear like:
1. Overhearing someone talking about their plane trip.

By the middle of the treatment you might be working on something like:
5. I’m making a phone call to reserve a flight.

Then there’s the Mother of All FEARS #10 which could be:
10. I’m on a plane and there’s turbulence.

As you increase the fear factor, the therapist always takes time to work you back to feeling relaxed and in charge of your nervousness before moving on to the next numbered item. The treatment goes as slow or fast as you’re ready. You can definitely speed things up by practicing relaxation and deep breathing in between sessions.


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2. Medicines
There are many types of medicine that can be used for fear of flying, but the top contenders are the benzodiazepines, aka sedatives. If you’re afraid of flying, you want to feel relaxed before you even get on the plane and you want it to wear off before you get behind the wheel.
Fast Acting (rapid onset) drugs: Assuming you’re only taking it for that one flight–not using it everyday, the fast acting drugs with a medium duration of effect work best. These are nice for relatively short flights.  If they work too fast though, you might find yourself falling asleep instead of just feeling relaxed.

That reminds me of a pharmacology joke, “What do you call a very fast-acting benzodiazepine?”
Answer: A sleeping pill.

The reason this is funny to psychopharm types like me, is because most people don’t realize that medicines like Ambien and Lunesta are very much like any other benzodiazepine but they are so fast acting and the effect ends so quickly that they turn out to be great for sleep: “Helps you fall asleep fast and wake up refreshed.” Sound like any commercials you know?

So, why not just take Lunesta or Ambien for the plane ride?
Answer: Some people do this for long trips overseas because they are up in the air for at least 7 hours which is about the duration of effect for these medicines. If the trip is shorter, you may find yourself being pulled over for a DUI because they impair your ability to drive, and OPERATE HEAVY MACHINERY. Insurance companies hate these drugs for just that reason, ACCIDENTS.

I don’t care about all this mind-numbing pharmacology, just give me the bottom line…what should I take for my next flight?

This question hurts me. I thought you would consider this fun and besides, I can’t  give medical advice on a blog post.  But, I am allowed to share information I received from a lecture at a Harvard class on these medicines. The speaker asked, “All things being equal what medicine would you give someone for Fear of Flying?

Audience shifts nervously.

Answer: Valium (diazepam).  It acts relatively quickly, and lasts long enough for most flights. Then he emphasized, “You don’t want your patients to lose the medicine effect and start panicking midway through their flight do you?”

Audience begins to feel panicky.

Some would argue that Xanax would be just as good, especially for short flights. The argument is a sound one because it is fast on, but also fast off (lasts a shorter time). So you and your doctor should decide.
If it’s a longer fight, you probably want something that lasts longer like valium. If it’s a short flight, it may be Xanax.


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3. Virtual Reality: This type of treatment takes advantage of 3-D gaming technology using headsets and sensors to immerse the patient in a 360-degree, visual and auditory computer simulation of air travel, from packing to security to boarding and taking flight. The software is able to simulate night or day. It can show various weather conditions and mimic turbulence. The technology syncs up with measures of  breathing, heart and perspiration rates too.

I knew there was a reason why are kids are playing video games all the time! They’re practicing for careers as psychologists!





One thought on “Top 3 Treatments for Fear of Flying

  1. Captain Tom Bunn LCSW

    These are three popular methods of treating flight phobia. The problem is, none are even close to adequate. Because of that, I began working to find a way to treat this problem. Thirty years and about 8,000 clients later, the methods developed have proven adequate. Full information is in my book, “SOAR: The Breakthrough Treatment for Fear of Flying,” which is already the best-selling book on the subject and gets rave reviews on Amazon and Barnes & Noble.

    CBT is not adequate for two reasons. First, being cognitive, its effectiveness disappears when stress hormones build up and cause the anxious flier’s cognitive ability to disappear. Second, CBT can – at best – stop only the release of stress hormones caused by thoughts; it cannot stop the release of stress hormones caused non-cognitively by the amygdala when the plane drops in turbulence or when an unexpected or unfamiliar noise is heard.

    Systematic Desensitization, as described here, is done in imagination. This means there is no desensitization to the actual risk or the experience of being up high and being unable to escape. The same is true of Virtual Reality Exposure Therapy: it does not desensitize to actual risk, actually being up high, and actually being unable to escape. It is, after all, done in an office. Anxious fliers know the difference. I was involved in the original VRET research; it didn’t work. But the people who promote it “spun” the research to make it appear to work for flying. It doesn’t.

    Medication? According to research at the Stamford University School of Medicine, benzodiazepines – when used for flying – completely block desensitization. Worse, each time the person flies medicated, they get more sensitive to the noises and motions. If a person flies only a very few times in their life, medication may be practical, but people who fly more will reach the point at which medication does nothing at all to help them.

    The method I developed, after stumbling on it while trying to be CBT to work more effectively, involves training the amygdala not to release stress hormones when flying. This is done by linking moments of flight to the memory of an interpersonal experience in which oxytocin – a hormone that inhibits the amygdala – is produced naturally. These experiences include nursing an infant, first seeing an infant, sexual foreplay and afterglow, and gazing into a pet’s eyes (apparently the devoted way pets look at us is how a lover should look at us in order for oxytocin it to be produced and quell fears of being intimate).

    More recently, research by Stephen Porges shows that when a person is empathically attuned to us, we become calm. The challenging moments of flight can also be linked to this interpersonal experience.

    Once links are established through practice session in the days leading up to the flight, the person is able to fly just as others do.

    Reply

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